Individual
MR. DEKODA DEWAYNE WARE SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
16921 S WESTERN AVE STE 203, GARDENA, CA 90247-5250
(310) 523-3225
(310) 668-7185
Mailing address
16921 S WESTERN AVE STE 203, GARDENA, CA 90247-5250
(310) 523-3225
(310) 668-7185
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
347E00000X
Transportation Broker
Primary
—
—
Other
Enumeration date
02/20/2009
Last updated
02/20/2009
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